Managing Post-Exertional Malaise (PEM): What can help?

Posted by sammy47 @sammy47, Apr 16, 2023

What can help Post Exertional Malaise crashes that is common with Long Covid same as with ME/CFS?

Interested in more discussions like this? Go to the Post-COVID Recovery & COVID-19 Support Group.

@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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@axh11 - My wife and I both got Covid 1st time on Feb 2nd. She seemed OK in about 7 days. During Covid, I was worse, fever, lost smell and taste for 5 days and other issues. I'm still having same symptoms as you, sluggish and tired. I feel like I'm coming down with the "bug" and never do. If I do more than perhaps I should, I'm exhausted later in day and next day. Still have chest cough and heavy felling in sinuses. Hard to explain but as you say, feeling unwell best describes it.

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@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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It is good to get tested to make sure you don't have cardiovascular or other covid-linked problems. I caught covid last March on a 7-day 350 mi bike ride and was sick for about a week. The long covid (LC) hit after that, and the main symptom was post-exertional malaise (PEM). So, I went from biking up to 80 mi/day to 5 mi on a exercise bike followed by a nap. Overall, I went from 100% to 30%. PEM is a waiting game, you can exercise/rest, but only to the extent that it doesn't trigger PEM because it can take hours or days for PEM to subside. If you are feeling "like your own self" one day, don't push it because the PEM crash is in the background. Resistance (weights) is easier than aerobic exercise. PEM is triggered by exertion, stress, not enough sleep, and who knows what else. Consider keeping a food log; covid can trigger food intolerances in some people (for me, it was celiac after having H1N1 years ago). My LC did go away, but it took 8 months.

This link is not a peer-reviewed paper, but has useful info: https://www.yalemedicine.org/news/long-covid-symptoms. These CDC guidelines are for doctors, so info more for what they should look for. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html

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@axh11

I have been back to work and daily activities for just a week since having Covid for the first time. Each time I try to do a light workout, I end up feeling exhausted and unwell. Following this thread in hopes of answers!

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Do NOT try to exercise right now! Google "post exertional malaise." At the moment, pushing yourself could lead to long-term worsening of symptoms. Rest as much as you can for the next month or two, then gradually increase activity and see if you can tolerate it without feeling worse the following day.

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@gryphon

Do NOT try to exercise right now! Google "post exertional malaise." At the moment, pushing yourself could lead to long-term worsening of symptoms. Rest as much as you can for the next month or two, then gradually increase activity and see if you can tolerate it without feeling worse the following day.

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You are absolutely right. For last few weeks, if I do a little too much one day, I can feel it the next day. I guess I need to nudge the throttle forward a little at a time, can't rush this. Your suggestion makes good sense.

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@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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Thank you all for sharing your experiences! I appreciate your support and advice. I had been pacing myself fairly well since I had the crash that prompted me to reach out to this community, but I am back in another (albeit milder) crash that started yesterday. I think this time it was triggered by driving - I was in the car for about 2 hours driving back/forth to appointments. I really find driving to be very exhausting because it’s just constant focus.

It’s really frustrating to accept that this is my life now, and really scary to not know how long it will last. Up until yesterday, I was feeling pretty good. Pacing myself for sure, but also functioning fairly well within those constraints. I had even convinced myself that I was improving and would be back to normal soon. The crash this week has made me realize that I am not out of the woods, that I am still vulnerable, and it scares me.

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@athenaatkins

Thank you all for sharing your experiences! I appreciate your support and advice. I had been pacing myself fairly well since I had the crash that prompted me to reach out to this community, but I am back in another (albeit milder) crash that started yesterday. I think this time it was triggered by driving - I was in the car for about 2 hours driving back/forth to appointments. I really find driving to be very exhausting because it’s just constant focus.

It’s really frustrating to accept that this is my life now, and really scary to not know how long it will last. Up until yesterday, I was feeling pretty good. Pacing myself for sure, but also functioning fairly well within those constraints. I had even convinced myself that I was improving and would be back to normal soon. The crash this week has made me realize that I am not out of the woods, that I am still vulnerable, and it scares me.

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I was a cereal breakfast person but after 2 covids I crash near 4-5 hours to last 6-7 I have to have a substantial Bft and a nap and a snack midmorning to get to 1PM. If i'm planning on going shopping I have to skip BP meds till I get back.
So goes the battle for 3 yrs. However I'm 86

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@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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My exercise routine in the morning is entirely floor-based. I've never experienced a sudden flare-up. It consists of 20 minutes of stretching, ten push-ups, and a brisk cold shower. Surprisingly, even minimal activities like cleaning the house or moving lightweight items can trigger flu-like symptoms that last from two to six hours. I make sure to pace myself. I've also been prescribed a low dose of LDN, which I'll start taking soon. I'm hopeful that LDN will restore some of my energy, allowing me to gently lift weights and engage in extended cardio sessions. Quick cold showers or immersing my head in cold water provide relief. Initially, I began this practice to alleviate my anxiety before the onset of my fatigue symptoms. I believe that my PEM is a result of severe trauma and stress.

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@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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There has begun a national clinical trial on treating PEM with a program of “Pacing” — where it’s determined what amount of activity is tolerable for each person. Then that person wears an activity monitor and is coached toward very gradually increasing it.

The clinical trial has only a few study sites now, but more will be added.

Look up “Pacing” related to PEM online.

May you experience a steady recovery!

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@athenaatkins

It’s been about five weeks since I got Covid, and I am struggling with the push-crash cycle of post exertional malaise. I was feeling good over the weekend and foolishly pushed my body too far with a 45 minute walk in the woods. Three days later I am still almost completely incapacitated by fatigue and plagued by muscle aches and headaches. My husband wants me to push myself a bit through the fatigue by getting back into our normal routine of walking the dogs for 15 minutes in the morning (which I had been tolerating), but I am not sure if that is a good thing to do while I am in the crash recovery phase.

I would like to get some advice on whether I should strictly rest until the fatigue subsides, or if it is better to add some light exercise into the mix so I don’t decondition even more. Honestly, I am terrified that I might do something that will prolong the fatigue, because it is having such a negative impact on my ability to work.

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At the risk of being redundant, I crashed after doing a 20 minute walk video. This was my first, and I need help. What do you do all day while recovering?
My crash is a feeling of weakness, deeper fatigue. I am able to do the same things but I just feel like moving slower. Any suggestions would be so appreciated.

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@mclelland1958

At the risk of being redundant, I crashed after doing a 20 minute walk video. This was my first, and I need help. What do you do all day while recovering?
My crash is a feeling of weakness, deeper fatigue. I am able to do the same things but I just feel like moving slower. Any suggestions would be so appreciated.

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I was a Research Coordinator for Human Subjects medical research. So, one thing I do is research the topic of Long Covid online.

And, I’m participating in the RECOVER-VITAL national clinical trial for treatment of Long Covid. That involves responding to 3 weekly online questionnaires, and making periodic in-person visits to the local study site.

I also research other health-related topics online.

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